2. Have you ever gone without health insurance?

3. Currently, how much does your household spend per year on all costs related to healthcare, including costs such as contributions to employer-sponsored health insurance, copays, coinsurance, deductibles, prescription drug purchases, and other out-of-pocket expenses?

4. Have your healthcare expenses gone up or down in the past year?

5. Have you or a member of your household ever put off receiving medical care or filling a prescription due to the cost?

6. Have you ever postponed or declined to seek any of the following types of healthcare due to a lack of coverage or an inability to afford it? Select all that apply.

7. Have you ever received a surprise bill for unexpected out-of-network care while insured?

8. Has an insurance company ever refused to pay for a medication or treatment prescribed by your doctor?

9. Have you ever received a medical bill with confusing or questionable charges?

10. Do you have medical debt?

11. Have you ever encountered long wait times for any of the following? Select all that apply:

12. Have you ever had to change doctors because your physician was no longer in-network, or because your insurance changed?

13. Have you ever had difficulty finding a doctor who is accepting new patients?

14. The New York Health Act would create a single-payer healthcare system in New York. It would be funded by a combination of payroll and income taxes that would be higher for higher income earners and lower for those who earn less, as well as funding from the federal government and other sources. It would eliminate costs like deductibles, co-pays, and other out-of-pocket expenses; 90% of New Yorkers would spend less on healthcare than they do at present. Should New York pass this law?

15. If you have any other healthcare experiences you would like to share, or any comments or ideas about improving healthcare in our area, feel free to write them in the open-ended space below.